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Gao T, Zou C, Li J, Han C, Zhang H, Li Y, Tang X, Fan Y. Identification of moyamoya disease based on cerebral oxygen saturation signals using machine learning methods. JOURNAL OF BIOPHOTONICS 2022; 15:e202100388. [PMID: 35102703 DOI: 10.1002/jbio.202100388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 06/14/2023]
Abstract
Moyamoya is a cerebrovascular disease with a high mortality rate. Early detection and mechanistic studies are necessary. Near-infrared spectroscopy (NIRS) was used to study the signals of the cerebral tissue oxygen saturation index (TOI) and the changes in oxygenated and deoxygenated hemoglobin concentrations (HbO and Hb) in 64 patients with moyamoya disease and 64 healthy volunteers. The wavelet transforms (WT) of TOI, HbO and Hb signals, as well as the wavelet phase coherence (WPCO) of these signals from the left and right frontal lobes of the same subject, were calculated. Features were extracted from the spontaneous oscillations of TOI, HbO and Hb in five physiological activity-related frequency segments. Machine learning models based on support vector machine (SVM), random forest (RF) and extreme gradient boosting (XGBoost) have been built to classify the two groups. For 20-min signals, the 10-fold cross-validation accuracies of SVM, RF and XGBoost were 87%, 85% and 85%, respectively. For 5-min signals, the accuracies of the three methods were 88%, 88% and 84%, respectively. The method proposed in this article has potential for detecting and screening moyamoya with high proficiency. Evaluating the cerebral oxygenation with NIRS shows great potential in screening moyamoya diseases.
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Affiliation(s)
- Tianxin Gao
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Chuyue Zou
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Jinyu Li
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Cong Han
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Houdi Zhang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Yue Li
- School of Medicine, Tsinghua University, Beijing, China
| | - Xiaoying Tang
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Yingwei Fan
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
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Chinda B, Tran KH, Doesburg S, Siu W, Medvedev G, Liang SS, Brooks-Wilson A, Song X. Functional MRI evaluation of cognitive effects of carotid stenosis revascularization. Brain Behav 2022; 12:e2512. [PMID: 35233977 PMCID: PMC9014987 DOI: 10.1002/brb3.2512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/10/2021] [Accepted: 01/07/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Severe internal carotid stenosis, if left untreated, can pose serious risks for ischemic stroke and cognitive impairments. The effects of revascularization on any aspects of cognition, however, are not well understood, as conflicting results are reported, which have mainly been centered on paper-based cognitive analyses. Here, we summarized and evaluated the publications to date of functional MRI (fMRI) studies that examined the mechanisms of functional brain activation and connectivity as a way to reflect cognitive effects of revascularization on patients with carotid stenosis. METHODS A PubMed and Google Scholar (covering the relevant literature until November 1, 2021) search yielded eight original studies of the research line, including seven resting-state and one task-based fMRI reports. RESULTS Findings demonstrated treatment-related alterations in fMRI signal intensity and symmetry level, regional fMRI activation pattern, and functional brain network connectivity. The functional brain changes were associated largely with improvement in cognitive function assessed using standard cognitive test scores. CONCLUSIONS These findings support the contribution of fMRI to the understanding of brain functional activation and connectivity changes revealing cognitive effects of revascularization in the management of severe carotid stenosis. The review also highlighted the importance of reproducibility through enhancing experimental designs and cognitive task applications with future research for potential clinical translation.
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Affiliation(s)
- Betty Chinda
- Department of Biomedical Physiology & Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada.,Clinical Research and Evaluation, Surrey Memorial Hospital, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Kim H Tran
- Department of Biomedical Physiology & Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada.,Clinical Research and Evaluation, Surrey Memorial Hospital, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Sam Doesburg
- Department of Biomedical Physiology & Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - William Siu
- Department of Radiology, Fraser Health Authority, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - George Medvedev
- Department of Neurology, Fraser Health Authority, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - S Simon Liang
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Angela Brooks-Wilson
- Department of Biomedical Physiology & Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada.,Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, British Columbia, Canada
| | - Xiaowei Song
- Department of Biomedical Physiology & Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada.,Clinical Research and Evaluation, Surrey Memorial Hospital, Fraser Health Authority, Surrey, British Columbia, Canada
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Imaging methods for surgical revascularization in patients with moyamoya disease: an updated review. Neurosurg Rev 2021; 45:343-356. [PMID: 34417671 PMCID: PMC8827314 DOI: 10.1007/s10143-021-01596-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 06/20/2021] [Accepted: 06/24/2021] [Indexed: 02/08/2023]
Abstract
Neuroimaging is crucial in moyamoya disease (MMD) for neurosurgeons, during pre-surgical planning and intraoperative navigation not only to maximize the success rate of surgery, but also to minimize postsurgical neurological deficits in patients. This is a review of recent literatures which updates the clinical use of imaging methods in the morphological and hemodynamic assessment of surgical revascularization in patients with MMD. We aimed to assist surgeons in assessing the status of moyamoya vessels, selecting bypass arteries, and monitoring postoperative cerebral perfusion through the latest imaging technology.
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Sleight E, Stringer MS, Marshall I, Wardlaw JM, Thrippleton MJ. Cerebrovascular Reactivity Measurement Using Magnetic Resonance Imaging: A Systematic Review. Front Physiol 2021; 12:643468. [PMID: 33716793 PMCID: PMC7947694 DOI: 10.3389/fphys.2021.643468] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/01/2021] [Indexed: 12/27/2022] Open
Abstract
Cerebrovascular reactivity (CVR) magnetic resonance imaging (MRI) probes cerebral haemodynamic changes in response to a vasodilatory stimulus. CVR closely relates to the health of the vasculature and is therefore a key parameter for studying cerebrovascular diseases such as stroke, small vessel disease and dementias. MRI allows in vivo measurement of CVR but several different methods have been presented in the literature, differing in pulse sequence, hardware requirements, stimulus and image processing technique. We systematically reviewed publications measuring CVR using MRI up to June 2020, identifying 235 relevant papers. We summarised the acquisition methods, experimental parameters, hardware and CVR quantification approaches used, clinical populations investigated, and corresponding summary CVR measures. CVR was investigated in many pathologies such as steno-occlusive diseases, dementia and small vessel disease and is generally lower in patients than in healthy controls. Blood oxygen level dependent (BOLD) acquisitions with fixed inspired CO2 gas or end-tidal CO2 forcing stimulus are the most commonly used methods. General linear modelling of the MRI signal with end-tidal CO2 as the regressor is the most frequently used method to compute CVR. Our survey of CVR measurement approaches and applications will help researchers to identify good practice and provide objective information to inform the development of future consensus recommendations.
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Affiliation(s)
- Emilie Sleight
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
| | - Michael S. Stringer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom,*Correspondence: Michael S. Stringer
| | - Ian Marshall
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
| | - Joanna M. Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
| | - Michael J. Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
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Roder C, Klose U, Hurth H, Brendle C, Tatagiba M, Ernemann U, Khan N, Hauser TK. Longitudinal Reproducibility of CO2-Triggered BOLD MRI for the Hemodynamic Evaluation of Adult Patients with Moyamoya Angiopathy. Cerebrovasc Dis 2021; 50:332-338. [PMID: 33556937 DOI: 10.1159/000513301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/14/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Hemodynamic evaluation of moyamoya patients is crucial to decide the treatment strategy. Recently, CO2-triggered BOLD MRI has been shown to be a promising tool for the hemodynamic evaluation of moyamoya patients. However, the longitudinal reliability of this technique in follow-up examinations is unknown. This study aims to analyze longitudinal follow-up data of CO2-triggered BOLD MRI to prove the reliability of this technique for long-term control examinations in moyamoya patients. METHODS Longitudinal CO2 BOLD MRI follow-up examinations of moyamoya patients with and without surgical revascularization have been analyzed for all 6 vascular territories retrospectively. If revascularization was performed, any directly (by the disease or the bypass) or indirectly (due to change of collateral flow after revascularization) affected territory was excluded based on angiography findings (group 1). In patients without surgical revascularization between the MRI examinations, all territories were analyzed (group 2). RESULTS Eighteen moyamoya patients with 39 CO2 BOLD MRI examinations fulfilled the inclusion criteria. The median follow-up between the 2 examinations was 12 months (range 4-29 months). For 106 vascular territories analyzed in group 1, the intraclass correlation coefficient was 0.784, p < 0.001, and for group 2 (84 territories), it was 0.899, p < 0.001. Within the total follow-up duration of 140 patient months, none of the patients experienced a new stroke. CONCLUSIONS CO2 BOLD MRI is a promising tool for mid- and long-term follow-up examinations of cerebral hemodynamics in moyamoya patients. Systematic prospective evaluation is required prior to making it a routine examination.
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Affiliation(s)
- Constantin Roder
- Center for Moyamoya and Cerebral Revascularization, Department of Neurosurgery, Eberhard Karls University Tübingen, Tübingen, Germany.,Interdisciplinary Center for Neurovascular Diseases Tübingen (ZNET), Tübingen, Germany
| | - Uwe Klose
- Department of Neuroradiology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Helene Hurth
- Center for Moyamoya and Cerebral Revascularization, Department of Neurosurgery, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Cornelia Brendle
- Department of Neuroradiology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Marcos Tatagiba
- Center for Moyamoya and Cerebral Revascularization, Department of Neurosurgery, Eberhard Karls University Tübingen, Tübingen, Germany.,Interdisciplinary Center for Neurovascular Diseases Tübingen (ZNET), Tübingen, Germany
| | - Ulrike Ernemann
- Department of Neuroradiology, Eberhard Karls University Tübingen, Tübingen, Germany.,Interdisciplinary Center for Neurovascular Diseases Tübingen (ZNET), Tübingen, Germany
| | - Nadia Khan
- Center for Moyamoya and Cerebral Revascularization, Department of Neurosurgery, Eberhard Karls University Tübingen, Tübingen, Germany, .,Moyamoya Center, University Children's Hospital Zürich, Zürich, Switzerland,
| | - Till-Karsten Hauser
- Department of Neuroradiology, Eberhard Karls University Tübingen, Tübingen, Germany
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Mutch WAC, El-Gabalawy R, Ryner L, Puig J, Essig M, Kilborn K, Fidler K, Graham MR. Brain BOLD MRI O 2 and CO 2 stress testing: implications for perioperative neurocognitive disorder following surgery. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:76. [PMID: 32131878 PMCID: PMC7057494 DOI: 10.1186/s13054-020-2800-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/18/2020] [Indexed: 12/17/2022]
Abstract
Background Mechanical ventilation to alter and improve respiratory gases is a fundamental feature of critical care and intraoperative anesthesia management. The range of inspired O2 and expired CO2 during patient management can significantly deviate from values in the healthy awake state. It has long been appreciated that hyperoxia can have deleterious effects on organs, especially the lung and retina. Recent work shows intraoperative end-tidal (ET) CO2 management influences the incidence of perioperative neurocognitive disorder (POND). The interaction of O2 and CO2 on cerebral blood flow (CBF) and oxygenation with alterations common in the critical care and operating room environments has not been well studied. Methods We examine the effects of controlled alterations in both ET O2 and CO2 on cerebral blood flow (CBF) in awake adults using blood oxygenation level-dependent (BOLD) and pseudo-continuous arterial spin labeling (pCASL) MRI. Twelve healthy adults had BOLD and CBF responses measured to alterations in ET CO2 and O2 in various combinations commonly observed during anesthesia. Results Dynamic alterations in regional BOLD and CBF were seen in all subjects with expected and inverse brain voxel responses to both stimuli. These effects were incremental and rapid (within seconds). The most dramatic effects were seen with combined hyperoxia and hypocapnia. Inverse responses increased with age suggesting greater risk. Conclusions Human CBF responds dramatically to alterations in ET gas tensions commonly seen during anesthesia and in critical care. Such alterations may contribute to delirium following surgery and under certain circumstances in the critical care environment. Trial registration ClincialTrials.gov NCT02126215 for some components of the study. First registered April 29, 2014.
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Affiliation(s)
- W Alan C Mutch
- Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, University of Manitoba, 2nd Floor, Harry Medovy House, 671 William Ave., Winnipeg, MB, R3E 0Z2, Canada. .,Canada North Concussion Network, .
| | - Renée El-Gabalawy
- Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, University of Manitoba, 2nd Floor, Harry Medovy House, 671 William Ave., Winnipeg, MB, R3E 0Z2, Canada.,Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada
| | - Lawrence Ryner
- Canada North Concussion Network.,Department of Radiology, University of Manitoba, Winnipeg, Canada.,Department of Physics, University of Manitoba, Winnipeg, Canada
| | - Josep Puig
- Department of Radiology, University of Manitoba, Winnipeg, Canada
| | - Marco Essig
- Canada North Concussion Network.,Department of Radiology, University of Manitoba, Winnipeg, Canada
| | - Kayla Kilborn
- Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, University of Manitoba, 2nd Floor, Harry Medovy House, 671 William Ave., Winnipeg, MB, R3E 0Z2, Canada
| | - Kelsi Fidler
- Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, University of Manitoba, 2nd Floor, Harry Medovy House, 671 William Ave., Winnipeg, MB, R3E 0Z2, Canada
| | - M Ruth Graham
- Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, University of Manitoba, 2nd Floor, Harry Medovy House, 671 William Ave., Winnipeg, MB, R3E 0Z2, Canada.,Canada North Concussion Network
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Zaki Ghali G, George Zaki Ghali M, Zaki Ghali E, Lahiff M, Coon A. Clinical utility and versatility of the petrous segment of the internal carotid artery in revascularization. J Clin Neurosci 2020; 73:13-23. [PMID: 31987635 DOI: 10.1016/j.jocn.2019.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 09/03/2019] [Accepted: 11/09/2019] [Indexed: 10/25/2022]
Abstract
Direct approaches to high cervical lesions, including tumors and aneurysms, carry significant risks. This renders alternative approaches desirable, with vascular disease amenable to exclusion and revascularization to the intracranial circulation, including the petrous or supraclinoid segments of the internal carotid artery (ICA). The cervicopetrous ICA bypass via saphenous venous grafting has proven an effective strategy for treating and excluding these lesions. In current practice, this is performed via an extradural subtemporal approach to access the petrous segment of the ICA and a cervical incision for access to the cervical ICA. The venous graft is alternately tunneled subcutaneously or in situ through the cervical ICA, with the latter eschewing external compression, kinking, and torsion, which increases risk of graft thrombosis with the former. Maxillary or middle meningeal arteries may also serve as donors to the petrous ICA. Moreover, the petrous ICA may be used as a donor in revascularization procedures, to the supraclinoid segment of the ICA and the middle cerebral artery, with petrous supraclinoid and petrous-MCA bypasses described. Clinical utility and operative approaches bypassing to or from the petrous ICA in revascularization procedures are reviewed and discussed.
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Affiliation(s)
- George Zaki Ghali
- United States Environmental Protection Agency, Arlington, VA, United States; Department of Toxicology, Purdue University, West Lafayette, IN, United States
| | - Michael George Zaki Ghali
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, TX, United States; Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 W Queen Lane, Philadelphia, PA 19129, United States.
| | - Emil Zaki Ghali
- Department of Medicine, Inova Alexandria Hospital, Alexandria, United States; Department of Urological Surgery, El Gomhoureya General Hospital, Alexandria, Egypt
| | - Marshall Lahiff
- Walton Lantaff Schoreder and Carson LLP, 9350 S Dixie Highway, Miami, FL 33156, United States
| | - Alexander Coon
- Department of Neurosurgery, Johns Hopkins University, 1800 Orleans Street, Baltimore, MD 21287, United States
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